Extremity Trauma

Upper extremity trauma usually involves a fracture of the shoulder or head of the humerus, dislocation of the humerus, humeral shaft fracture, elbow fracture, radial and ulnar fractures and wrist or hand fractures. Because a person in a motor vehicle accident often braces themselves with their hand, they fracture one or more bones in the upper extremity as the forces push into the hand from the motor vehicle accident and “give” somewhere along the course of the upper extremity. Upper extremity injuries can also include sprains and nerve injuries, such as carpal tunnel syndrome. Carpal tunnel syndrome occurs when the median nerve is impinged in the carpal tunnel of the wrist because of repetitive trauma or a sudden trauma that damages the carpal tunnel and causes impingement of the nerve. Lower extremity trauma can be anything from a pelvic fracture, hip fracture, patellar fracture, tibia and fibula fracture, ankle fracture, or foot fracture. There can also be dislocations of the patella and the hip. Most of these injuries are caused by motor vehicle accidents. The force of the accident can cause the foot to brace in the footwell of the car, causing fractures of the long bones, the hip or the pelvis. The knee can be where the force originates, leading to things like “dashboard knee” or even a patellar fracture. The fractures can be displaced or nondisplaced, depending on the injury. Displaced fractures are more severe because the bony fracture segments are not in the correct position. They must be fixed by external reduction or internal reduction (in the operating room). Nondisplaced fractures are easier to repair but still might need surgery for internal fixation of the fracture with plates, screws or rods, among other choices.

Causes of Extremity FracturesExtremity fractures are common fractures that can be caused by any number of injurious conditions. They happen because of the following conditions:

• Automobile injuries
• Motorcycle accidents
• All-terrain vehicle accidents
• Falls from a great height
• Bicycle accidents
• Altercations
• Falls from a standing position
• Sports-related accidents

These things involve forces that can be so great they can cause an extremity sprain, strain or fracture, the most serious being a fracture.

Symptoms of an Extremity FractureThe symptoms of an extremity fracture vary widely according to the location of the fracture. The pain is usually located at the site of the injury, and there can be distal disruption of the nerves or blood vessels in any fracture that causes numbness, tingling or coldness to the part of the body distal to the fracture. The main symptoms of an upper extremity fracture are:

• Pain and swelling in the affected area
• Obvious deformity at the site of the fracture
• Inability to effectively use the arm due to problems in the affected area
• Bruising, warmth, or redness of the affected area

The main symptoms of a lower extremity fracture include:

• Inability to walk on the affected leg
• Instability of the leg
• Deformity of the affected area
• Distal coolness, numbness or paralysis of the extremity
• Pain at the site of the fracture

It is up to the attending physician to take a thorough history and physical examination to find out the most obvious place of injury and proceed further with diagnostics.

The diagnosis of extremity injuries includes first doing a plain film x-ray on the affected area to look for fractures. Most fractures are easy to see on plain film x-ray. In situations in which a fracture is expected but not seen on plain film, a CT scan or MRI scan can look carefully at the bone so that non-displaced fractures can be seen. The MRI has the added advantage of being able to show any soft tissue damage or hematomas from the injury.If there is a suspected nerve injury, the doctor can use an electromyogram to check the nerve function of muscles distal to the injury. A nerve stimulation test can be done to see if the fracture or other injury had impinged on a nerve. Doppler ultrasound can assess the pulses distal to the injury to assess whether or not the arterial blood flow has been injured. This kind of injury requires emergent surgery to restore circulation to the affected arm or leg.

Treatment of Extremity InjuriesThere are first aid and definitive treatment of extremity fractures. The first aid treatment of extremity injuries includes the following:

• Apply ice to the swollen or painful areas
• Do not move the extremity.
• Take Aleve, Advil, or Tylenol
• Brace the extremity if you have the tools for that.
• Activate EMS if needed for transport or for other injuries.

Once at the hospital or clinic, the patient needs to have a physical exam, history, and x-rays to determine the site of injury and makeup of fracture. The fracture can be treated with closed reduction and external casting, which is the easiest way to treat minor fractures. The doctor will use the x-rays to guide putting together the bony ends so that they are in anatomic configuration. In addition, the patient needs to use a splint or cast to keep the fracture in anatomic alignment for about 6 weeks. It's crucial to replace the cast if there is atrophy of the muscles making the cast not able to keep the fractured ends in anatomic alignment because the cast is too big. The doctor may rely on open reduction and internal fixation. This means doing surgery to put the fragments of bone into whatever alignment is most appropriate—hopefully completely anatomical. The surgery goes on to use hardware, such as an intramedullary rod, plates, and screws, or wires in order to fix the bone into place. There are multiple techniques for this that differ according to the part of the extremity and type of fracture involved. It will take about 3-6 weeks for the fracture to heal.

Complications of Extremity FracturesNot all extremity fractures heal perfectly, and there can be long-term complications, including:

• Persistent deformity of the extremity
• Lack of complete function of the extremity
• Lack of nerve function distal to the injury
• Poor circulation past the injury
• Amputation secondary to failure of healing of the injury or severe crush injury.

To understand more about extremity trauma, here's a video from Stryker's channel to guide you:

Upon identifying the upper and lower extremity injuries, be sure to take actions for immediate therapies and treatments necessary. If you or a loved one has suffered extremity trauma as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 to set up a FREE consultation.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 10.28.20]